Network analysis of subjective happiness, hope and resilience in the Paraguayan general population during the post-COVID-19 pandemic period / Análisis en red de felicidad subjetiva, esperanza y resiliencia en la población general paraguaya en la pospandemia del COVID-19

Abstract Introduction/objective: In this cross-sectional study, the connections between indicators of subjective happiness, hope, and resilience were investigated in 591 adult Paraguayans (average age 37.7 years; SD = 11.35) during the COVID-19 post-pandemic period, using network analysis for the first time. Method: The indicators of subjective happiness, hope, and resilience were assessed using the Subjective Happiness Scale, the Adult Hope Scale, and the 10-item Connor-Davidson Resilience Scale, respectively. Result: The results indicated that "Enjoy life in spite of it all," "Pursuing goals," and "Coping with stress" were the most central indicators of the resilience, hope, and subjective happiness network. While stronger conditional relationships were observed between indicators of the same network variable, potential bridge indicators were also noted that could link resilience, hope, and subjective happiness, such as "I am a strong person," "Enjoy life in spite of it all," "Pursuing goals," and "I have been successful in life." Conclusions: The results suggest that timely and multilevel interventions targeted at central and bridge indicators can help promote positive emotions that impact mental health.

Resumen Introducción/objetivo: En este estudio transversal se investigaron las conexiones entre los indicadores de felicidad subjetiva, esperanza y resiliencia en 591 paraguayos adultos (edad promedio 37.7 años; DE = 11.35) en el período pospandemia del COVID-19 utilizando análisis de redes por primera vez. Método: Los indicadores de felicidad subjetiva, esperanza y resiliencia se evaluaron utilizando la Escala de Felicidad Subjetiva, la Escala de Esperanza del Adulto y la Escala de Resiliencia de Connor-Davidson de 10 ítems, respectivamente. Resultados: Los resultados indicaron que "Disfrutar la vida a pesar de todo", "Perseguir metas" y "Afrontar el estrés" fueron los indicadores más centrales de la red de resiliencia, esperanza y felicidad subjetiva. Si bien se observaron relaciones condicionales más fuertes entre indicadores de la misma variable de red, también se observaron posibles indicadores puente que podrían vincular la resiliencia, la esperanza y la felicidad subjetiva, como "Soy una persona fuerte", "Disfruta la vida a pesar de todo", "Persiguiendo metas" y "He tenido éxito en la vida". Conclusiones: Los resultados sugieren que las intervenciones oportunas y multinivel dirigidas a indicadores centrales y puente pueden ayudar a promover emociones positivas que impacten la salud mental.

The Mpox outbreak is a public health emergency of international concern: Implications for mental health and global preparedness.

BACKGROUND: The Mpox, a zoonotic viral disease that has historically affected Central and West Africa, has been declared a Public Health Emergency of International Concern by the World Health Organization. Rapid transmission and recent dissemination in Africa may imply significant challenges to global health, including mental health. METHODS: We reviewed the mental health implications of the Mpox outbreak according to the published literature. We also discussed the psychological effects of the global spreading of this infection and public health preparedness strategies. Key areas of intervention may include the epidemiological surveillance, vaccine development, and mental health strategies. COMMENTS: The Mpox outbreak calls for a robust global preparedness to address potential health emergencies. Strengthening epidemiological surveillance, ensuring equitable vaccine distribution, and building resilient public health infrastructure are crucial. Additionally, addressing mental health consequences may require immediate, intermediate, and long-term strategies, including telepsychiatry, stress management training, and the integration of mental health into primary care.

Could school programs based on social-emotional learning prevent substance abuse among adolescents?

In this editorial, we comment on the article Adolescent suicide risk factors and the integration of social-emotional skills in school-based prevention programs by Liu et al. While the article focused on the issue of suicide and social-emotional learning programs as a possible intervention, we here discuss evidence of other reported outcomes and if it could be an effective way to prevent substance abuse among adolescents.

Clustering of methamphetamine users based on personality characteristics and self-efficacy in the west of Iran.

With the substantial increase in the use of stimulants, especially methamphetamine, in recent years, the present study aimed to cluster methamphetamine users based on personality traits and self-efficacy, and compare their mental health, sleep quality, and the risk of relapse in the identified clusters. This cross-sectional study was conducted through convenience sampling on 501 methamphetamine users in addiction treatment centers in Kermanshah, western Iran. The data were collected using the Schwarzer General Self-Efficacy Scale, Zuckerman-Kuhlman Personality Questionnaire, Goldberg and Hiller General Health Questionnaire (GHQ), Zuckerman-Kuhlman Personality Questionnaire, and Stimulant Relapse Risk Scale (SRRS). A total of 501 methamphetamine users were distinguished into three clusters with frequencies of 111 (22.2%), 298 (59.5%), and 92 (18.4%) members through hierarchical cluster analysis. The participants in the first cluster were characterized by low self-efficacy, high neuroticism, sensation seeking, and aggressiveness, along with low extroversion and activity, low positive health, high negative health, low sleep quality, and high risk of drug relapse. The participants in the second cluster reported moderate levels of self-efficacy, neuroticism, sensation seeking, activity, and aggressiveness, high extroversion, and moderate levels of mental health, sleep quality, and the risk of relapse. Moreover, the participants in the third cluster reported the highest level of self-efficacy, the lowest level of neuroticism, sensation seeking, and aggressiveness, moderate extroversion and high activity, low relapse risk, high sleep quality, as well as high positive and low negative health symptoms. The third cluster was significantly different from the other two clusters in terms of the mentioned factors. The findings of this study suggest that low self-efficacy and the presence of neuroticism, sensation seeking, and high aggressiveness contribute to reduced mental health and sleep quality, as well as an increased risk of relapse in methamphetamine users.

The S20 Brazilian Mental Health Report for Building a Just World and a Sustainable Planet: Part I.

This is the first part of two documents prepared by experts for the Brazilian S20 mental health report. These reports outline strategies aimed at addressing the exacerbated mental health challenges arising from a post-pandemic world. Ongoing psychiatric epidemiology research has yielded evidence linking mental health with intricate social determinants, including gender, race/ethnicity, racism, socioeconomic status, social deprivation, and employment, among others. More recently, the focus has expanded to also encompass violence and social oppression. By prioritizing prevention and early intervention, harnessing technology, and fostering community support, we can mitigate the long-term impact of mental disorders emerging in life. Utilizing evidence-based practices and forging partnerships between the health and education sectors, S20 countries can promote health and safety of their student population, thereby paving the way for a more promising future for the next generations. The first document focuses on addressing the mental health concerns of vulnerable populations, catering to the needs of children, youth, and aging populations, assessing the current state of alcohol and drug addictions, scaling up psychosocial interventions in primary care, exploring the potential integration of health and educational systems, and emphasizing the imperative adoption of human rights in mental health policies.

Masculinity stigma and metastatic prostate cancer: A review with a focus on Latin America.

BACKGROUND: This review examines the impact of masculinity stigma on the diagnosis and treatment of metastatic prostate cancer, particularly in Latin America. It aims to provide insights into the influence of masculinity stigma on patient outcomes and inform strategies to address this issue. METHODS: A comprehensive search was conducted in electronic databases (PubMed, PsycINFO, CINAHL and LILACS) using relevant keywords and controlled vocabulary related to metastatic prostate cancer, masculinity, stigma, diagnosis, and treatment up to April 2023. The search strategy was developed in consultation with a medical librarian to ensure its comprehensiveness. Thirty-three studies that investigate the role of masculinity stigma in the diagnosis and treatment of metastatic prostate cancer were included. RESULTS: Our findings highlight the unique sociocultural influences in Latin America that shape prostate cancer stigma. It emphasizes the impact of cultural beliefs, gender norms, and social expectations on stigma. Notions of masculinity, such as strength and invulnerability, contribute to the stigmatization of prostate cancer. Machismo culture and religious/spiritual beliefs further compound the challenges and hinder open communication about the disease. Cultural taboos, limited awareness, and misconceptions perpetuate the stigma. CONCLUSIONS: These sociocultural factors shape the experiences and challenges faced by individuals with and at risk of prostate cancer in Latin America.

Addressing Mental Health Needs in Low- and Middle-Income Countries: The case of São Caetano do Sul, Brazil.

São Caetano do Sul, a city in southeastern Brazil, boasts exemplary social indicators and healthcare services, with a population of 162,763 and a density of 9,736.03 inhabitants/km². Allocating 25% of its budget to healthcare, the city's mental healthcare services adhere to the National Mental Health Policy. Structured services include a CAPS-II, CAPS-AD, outpatient teams, and teams in various locations. Initiatives since 2000 include inaugurating a CAPS-AD in 2006, a psychiatric emergency service in 2010, and a CAPS-II in 2016, relocating CAPS-AD in 2019, and establishing the Cuca Legal Project in 2022. São Caetano do Sul has a Mental Health Risk Classification Protocol to aid clinical decision-making. Developing care lines for various groups, it offers programs like smoking prevention, school psychology, and obesity support. Collaborating with community centers, these facilities serve as teaching environments. The mental health care network focuses on five axes: Communication, Care, Prevention, Management, and Education, with specific proposed actions and competencies. Despite progress, challenges remain. Expanding access, reducing stigma, and implementing robust monitoring are crucial. São Caetano do Sul's experience offers valuable insights for similar urban settings in LMICs developing mental health programs.

Mapping the Neural Substrates of Cocaine Craving: A Systematic Review.

Craving is one of the most important symptoms of cocaine use disorder (CUD) since it contributes to the relapse and persistence of such disorder. This systematic review aimed to investigate which brain regions are modulated during cocaine craving. The articles were obtained through searches in the Google Scholar, Regional BVS Portal, PubMed, and Scielo databases. Overall, there was a selection of 36 studies with 1574 individuals, the majority being participants with CUD, whereby about 61.56% were individuals with CUD and 38.44% were controls (mean age = 40.4 years). Besides the methodological points, the neurobiological investigations comprised fMRI (58.34%) and PET (38.89%). The induction of cocaine craving was studied using different methods: exposure to cocaine cues (69.45%), stressful stimuli, food cues, and methylphenidate. Brain activations demonstrated widespread activity across the frontal, parietal, temporal, and occipital lobes, basal ganglia, diencephalon, brainstem, and the limbic system. In addition to abnormalities in prefrontal cortex activity, abnormalities in various other brain regions' activity contribute to the elucidation of the neurobiology of cocaine craving. Abnormalities in brain activity are justified not only by the dysfunction of dopaminergic pathways but also of the glutamatergic and noradrenergic pathways, and distinct ways of inducing craving demonstrated the involvement of distinct brain circuits and regions.

Mental Health News during the COVID-19 Pandemic: A 3-year analysis in Paraguay / Noticias sobre Salud Mental durante la pandemia de COVID-19: Un análisis de 3 años en Paraguay

Introduction. The connection between news sources and the connotation of mental health articles in Paraguay during the COVID-19 pandemic (2020-2023) significantly impacted public opinion about mental health. Objective.This study analyzednews onmental health in Paraguay in the context of the COVID-19 pandemic. Material and methods.A descriptive retrospective study of all news articles on mental health published in the three primary newspapers of the country between May 2020 and May 2023 was conducted. The keywords were depressive disorders, anxiety disorders, bipolar disorder, schizophrenia, and mental health issues. Results. A total of 534 newswereexamined, 39.5% published by La Nación newspaper, 33.1% in 2023, and in 88.4% the author's identity and gender were not specified. Of the writing characteristics, 99.8% were written in the third person, 62.7% had a human-interest context,48.5% had a neutral connotation, 65.7% focused on health and well-being,and 7.5% written by health experts. The year of publication wasstatistically associated to connotation (p=0.003) and context (p<0.001). Conclusion. The media has paid significant attention to mental health. Despite the objectivity provided by third-person narration, problems arise because of a lack of author identification. To encourage balanced and non-polarized reporting, it is crucial to incorporate expert voices and promote the framing of mental health stories as "human interest". Palabras clave: mental health; news; newspaper article; COVID-19; Paraguay

Introducción. La conexión entre las fuentes de noticias y la connotación de los artículos sobre salud mental en Paraguay durante la pandemia de COVID-19 (2020-2023) impactó significativamente en la opinión pública sobre la salud mental. Objetivo. Analizar las noticias sobre salud mental en Paraguay en el contexto de la pandemia COVID-19. Material y métodos. Se realizó un estudio descriptivo retrospectivo de todos los artículos periodísticos sobre salud mental publicados en los tres principales periódicos del país entre mayo de 2020 y mayo de 2023. Las palabras clave fueron trastornos depresivos, trastornos de ansiedad, trastorno bipolar, esquizofrenia y problemas de salud mental. Resultados. Se examinaron 534 artículos periodísticos, 39,5% publicados por el diario La Nación, 33,1% en 2023y en 88,4%no se especificó la identidad ni el género del autor. De las características de redacción, el 99,8% estaban escritos en tercera persona, 62,7% pertenecían a un contexto de interés humano,48,5% tenían una connotación neutra, 65,7% se centraban en la salud y el bienestar y el 7,5% escritos por expertos en salud. El año de publicación se asoció significativamente con la connotación (p=0,003) y con el contexto (p<0,001). Conclusión. Los medios de comunicación han prestado gran atención a la salud mental. A pesar de la objetividad que aporta la narración en tercera persona, surgen problemas por la falta de identificación del autor. Para fomentar una información equilibrada y no polarizada, es crucial incorporar voces expertas y promover el encuadre de las historias de salud mental como "interés humano". Key words: salud mental; noticias; artículo de periódico; COVID-19;Paraguay

Caracterización Epidemiológica de los Pacientes de la Clínica Ambulatoria del Departamento de Psiquiatría de la Infancia y la Adolescencia de un Hospital Universitario de Paraguay: Estudio Trienal

El tema de la salud mental en niños y adolescentes requiere mayor atención. Por lo tanto, este estudio tuvo como objetivo determinar las características de los pacientes de consulta externa de un centro especializado de un hospital universitario paraguayo. Este estudio empleó una serie retrospectiva, no probabilística, de casos consecutivos. Se examinaron las historias clínicas de pacientes de ambos sexos, de entre 2 y 17 años de edad, que solicitaron consulta en el Departamento de Psiquiatría del Niño y del Adolescente del Hospital de Clínicas entre julio de 2021 y julio de 2023, y que fueron diagnosticados con un trastorno mental según la CIE-10. Se recogieron datos demográficos y clínicos de 447 pacientes, representando 1278 consultas. La mayoría de los pacientes eran mujeres (57,7%), con una edad media de 13 ± 3 años. La mayoría de los pacientes (57,3%) procedían del Departamento Central, el 61,5% eran de zonas rurales y el 72% no tenían seguro médico. Los diagnósticos más frecuentes fueron episodios depresivos (F32), otros trastornos de ansiedad (F41), trastornos de conducta (F91) y trastornos específicos de la personalidad (F60). Los resultados de este estudio proporcionan información crucial sobre la salud mental de niños y adolescentes, que es esencial para informar las políticas de salud mental, asignar recursos y formar a los profesionales sanitarios encargados de atender a este grupo de pacientes.

The topic of mental health in children and adolescents requires increased attention. Therefore, this study aimed to determine the characteristics of outpatient clinic patients at a specialized center within a Paraguayan University Hospital. This study employed a retrospective, non-probabilistic series of consecutive cases. The medical records of patients of both sexes, aged between 2 and 17 years, who sought consultation at the Department of Child and Adolescent Psychiatry of the Hospital de Clínicas between July 2021 and July 2023, and were diagnosed with a mental disorder according to the ICD-10, were examined. Demographic and clinical data were collected from 447 patients, representing 1278 consultations. The majority of the patients were female (57.7%), with a mean age of 13 ± 3 years. Most patients (57.3%) were from the Central Department, 61.5% were from rural areas, and 72% did not have medical insurance. The most frequent diagnoses were depressive episodes (F32), other anxiety disorders (F41), conduct disorders (F91), and specific personality disorders (F60). The findings of this study provide crucial information on child and adolescent mental health, which is essential for informing mental health policies, allocating resources, and training healthcare professionals tasked with caring for this patient group.

Drug use among medical students in São Paulo, Brazil: a cross-sectional study during the coronavirus disease 2019 pandemic

ABSTRACT BACKGROUND: Medical students demonstrate higher rates of substance use than other university students and the general population. The challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic raised significant concerns about mental health and substance use. OBJECTIVES: Assess the current prevalence of substance use among medical students at the University of São Paulo and evaluate the impact of the COVID-19 pandemic on drug consumption. DESIGN AND SETTING: A cross-sectional study was conducted on 275 medical students from the University of São Paulo Medical School (São Paulo, Brazil) in August 2020. METHODS: Substance use (lifetime, previous 12 months, and frequency of use before and during the COVID-19 pandemic) and socioeconomic data were assessed using an online self-administered questionnaire. Symptoms of depression were assessed using the Patient Health Questionnaire-9. RESULTS: Alcohol was the most consumed substance in their lifetime (95.6%), followed by illicit drugs (61.1%), marijuana (60%), and tobacco (57.5%). The most commonly consumed substances in the previous year were alcohol (82.9%), illicit drugs (44.7%), marijuana (42.5%), and tobacco (36%). Students in the first two academic years consumed fewer substances than those from higher years. There was a decreasing trend in the prevalence of most substances used after the COVID-19 pandemic among sporadic users. However, frequent users maintained their drug use patterns. CONCLUSION: The prevalence of substance use was high in this population and increased from the basic to the clinical cycle. The COVID-19 pandemic may have affected the frequency of drug use and prevalence estimates.

Hope, resilience and subjective happiness among general population of Paraguay in the post COVID-19 pandemic.

BACKGROUND: Positive mental health includes not only the absence of mental disorders but also the presence of subjective well-being, good coping strategies for life stress, and strategies for adapting to community life. It is well known that the COVID-19 pandemic has challenged mental health in general population worldwide. However, research has not measured protective factors for mental health in the general population after the declared end of pandemic by the World Health Organization. METHODS: This observational, cross-sectional study surveyed 591 Paraguayan participants aged ⩾18 years, who were recruited through an online survey. Demographic characteristics, socioeconomic status were collected as well as mental health and validated tools for hope, resilience, subjective happiness were administered. RESULTS: Of the participants, 81.6% were women, 54% were married or in a relationship and 90.7% reported an university education. The main source of stress was economic issues (30.3%). A total of 22.7% had been previously diagnosed with a mental disorder, 22.2% had consulted a mental health professional and 10.8% had consumed prescription drugs. 42.6% reported flourishing, 36.2% reported moderate and 21.2% reported languishing mental health. CONCLUSIONS: This large survey has shown that most of participants reported a flourishing mental health with high ratings at hope, resilience, and subjective happiness scales. Also, the main sources of stress were economic issues, not consequently related to the pandemic. This may add evidences to the international debate on the long term effects of the global pandemic and probably suggests that recovery processes have been collectively adopted in Paraguay.

Autolesión no suicida en población general: frecuencia y factores asociados en Paraguay

Introducción: La investigación sobre la autolesión no suicida permite aumentar la conciencia sobre este fenómeno, posibilita su detección temprana y la implementación de estrategias más eficaces en prevención y tratamiento. Esto conlleva a una reducción del sufrimiento individual, los costos económicos y el impacto en la sociedad en su totalidad. Objetivo: Determinar la frecuencia y factores asociados a autolesión no suicida en una muestra de población adulta de Paraguay. Metodología: Estudio descriptivo de asociación cruzada, de corte transversal y prospectivo. Una encuesta en línea fue difundida a través de redes sociales y aplicaciones de mensajería. Esta incluía preguntas sobre datos sociodemográficos y clínicos. La presencia de autolesiones se determinó a través de la versión en español de la escala Self-Harm Questionnaire. Se utilizó estadística descriptiva para todas las variables. Para buscar asociaciones se utilizó la prueba chi cuadrado. Resultados: Participaron 241 personas (media de edad=32±12 años, 74,7% mujeres). Se encontró una frecuencia de autolesiones de 24,5% (n=59). De estos, el 91,5% había tenido ideación suicida al menos una vez. Se encontró asociación entre el nivel de ingresos y la frecuencia de autolesiones (χ

Introduction: Research on non-suicidal self-injury raises awareness of this phenomenon, enabling the early detection and implementation of more effective strategies in prevention and treatment. This leads to a reduction in individual suffering, economic costs, and impact on society. Objective: To determine the frequency and associated factors of non-suicidal self-injury in a sample of the adult population of Paraguay. Methodology: This was a descriptive, cross-sectional, and prospective study. An online survey was disseminated through social networks and messaging applications. The survey included questions on sociodemographic and clinical data. The presence of self-injury was determined by using the Spanish version of the Self-Harm Questionnaire. Descriptive statistics were used for all the variables. The chi-square test was used to examine associations. Results: There were 241 participants (mean age=32±12 years, 74.7%female). A non-suicidal self-injury frequency of 24.5% (n=59) was observed. Of these, 91.5% reported suicidal ideation at least once. An association was found between income level and the frequency of non-suicidal self-injury (χ

Autolesiones no suicidas en estudiantes de medicina: frecuencia y factores asociados / Non-suicidal Self-injury in Medical Students: Frequency and Associated Factors

Introducción: la salud mental de los estudiantes de medicina ha sido ampliamente investigada, demostrando que forman parte de un grupo vulnerable al desarrollo de trastornos mentales. Objetivo: el objetivo de esta investigación fue determinar la frecuencia de NSSI y sus factores asociados en estudiantes de medicina del Paraguay. Metodología: este fue un estudio descriptivo y transversal. Se lanzó una encuesta online para evaluar depresión, ansiedad y autolesiones, se utilizaron las escalas PHQ-2, GAD-7 y SHQ, respectivamente. Resultados: recibimos respuestas de 330 estudiantes de medicina. De los participantes, el 71,2 % eran mujeres. Se identificó que el 46,4 % de los participantes padecía depresión (PHQ-2 ≥ 3) y el 37,3 % ansiedad (GAD-7 ≥10). La frecuencia de NSSI fue del 27 % (n = 89). Los principales factores asociados a NSSI fueron un diagnóstico previo de un trastorno mental (que aumentó la probabilidad de NSSI en 3,76 veces) y/o una historia de abuso físico o sexual (con un aumento de 3,75 veces). Conclusión: esta investigación encontró la presencia de NSSI en casi 3 de cada 10 de los estudiantes de medicina encuestados. Los principales factores asociados con la conducta autolesiva fueron un diagnóstico previo de un trastorno mental y/o antecedentes de abuso físico o sexual.

Introduction: the mental health of medical students has been extensively researched, showing that they are part of a group vulnerable to the development of mental disorders. Aim: the aim of this research was to determine the frequency of NSSI and its associated factors in medical students in Paraguay. Methodology: this was a descriptive and cross-sectional study. An online survey was launched to assess depression, anxiety, and self-harm, the PHQ-2, the GAD-7 and SHQ scales were used, respectively. Results: we received responses from 330 medical students. Of the participants, 71.2 % were female. 46.4% of the participants were identified as having depression (PHQ-2 ≥ 3) and 37.3 % as having anxiety (GAD-7 ≥10). The frequency of NSSI was 27 % (n = 89). The main factors associated with NSSI were a previous diagnosis of a mental disorder (which increased the likelihood of NSSI by 3.76 times) and/ or a history of physical or sexual abuse (with a 3.75-fold increase). Conclusion: this research found the presence of NSSI in almost 3 out of 10 of the medical students surveyed. The main factors associated with self-injurious behavior were a previous diagnosis of a mental disorder and/or a history of physical or sexual abuse.

Autolesiones no suicidas en estudiantes de medicina: frecuencia y factores asociados

Introducción: la salud mental de los estudiantes de medicina ha sido ampliamente investigada, demostrando que forman parte de un grupo vulnerable al desarrollo de trastornos mentales. Objetivo: el objetivo de esta investigación fue determinar la frecuencia de NSSI y sus factores asociados en estudiantes de medicina del Paraguay. Metodología: este fue un estudio descriptivo y transversal. Se lanzó una encuesta online para evaluar depresión, ansiedad y autolesiones, se utilizaron las escalas PHQ-2, GAD-7 y SHQ, respectivamente. Resultados: recibimos respuestas de 330 estudiantes de medicina. De los participantes, el 71,2 % eran mujeres. Se identificó que el 46,4 % de los participantes padecía depresión (PHQ-2 ≥ 3) y el 37,3 % ansiedad (GAD-7 ≥10). La frecuencia de NSSI fue del 27 % (n = 89). Los principales factores asociados a NSSI fueron un diagnóstico previo de un trastorno mental (que aumentó la probabilidad de NSSI en 3,76 veces) y/o una historia de abuso físico o sexual (con un aumento de 3,75 veces). Conclusión: esta investigación encontró la presencia de NSSI en casi 3 de cada 10 de los estudiantes de medicina encuestados. Los principales factores asociados con la conducta autolesiva fueron un diagnóstico previo de un trastorno mental y/o antecedentes de abuso físico o sexual.

Introduction: the mental health of medical students has been extensively researched, showing that they are part of a group vulnerable to the development of mental disorders. Aim: the aim of this research was to determine the frequency of NSSI and its associated factors in medical students in Paraguay. Methodology: this was a descriptive and cross-sectional study. An online survey was launched to assess depression, anxiety, and self-harm, the PHQ-2, the GAD-7 and SHQ scales were used, respectively. Results: we received responses from 330 medical students. Of the participants, 71.2 % were female. 46.4% of the participants were identified as having depression (PHQ-2 ≥ 3) and 37.3 % as having anxiety (GAD-7 ≥10). The frequency of NSSI was 27 % (n = 89). The main factors associated with NSSI were a previous diagnosis of a mental disorder (which increased the likelihood of NSSI by 3.76 times) and/ or a history of physical or sexual abuse (with a 3.75-fold increase). Conclusion: this research found the presence of NSSI in almost 3 out of 10 of the medical students surveyed. The main factors associated with self-injurious behavior were a previous diagnosis of a mental disorder and/or a history of physical or sexual abuse.

Dermatitis Artefacta: A Practical Guide for Diagnosis and Management.

Dermatitis artefacta (DA) is a psycho-dermatologic condition based on patients' behavioral patterns, characterized by an intentional production of cutaneous lesions on their own skin. The clinical presentation can be highly variable. Patients with DA seldom seek psychological support or psychiatric consultation. More often, they seek help from their primary care physician or dermatologist. This review article aims to provide a practical guide for the diagnosis and management of AD and affected patients. A broad literature search was performed using the PubMed and Google Scholar electronic online databases, using key words "dermatitis artefacta", "diagnosis", "management", and "psychodermatology". The search was limited to English and Spanish language articles and was supplemented with themed books and book chapters. DA can occur in a variety of clinical presentations, and physicians should suspect DA in patients with a history of psychiatric disorders or extensive use of healthcare services. The ultimate goal of DA treatment may be a proper referral to mental health services. However, the prognosis is poor even when successful mental health referrals are achieved, with low recovery rates. A useful approach may include the suggestion that a mental health provider can help with the anxiety and the distress generated by the lesions: in this case in this case it will be crucial to discuss this with the mental health provider after obtaining informed consent from the patient. Considering the difficulty in promoting patients' adherence to treatment, the ideal setting for DA treatment is a psycho-dermatologic clinic, where both dermatologic and psychological interventions can be seamlessly integrated.

Effects of Caffeine on Main Symptoms in Children with ADHD: A Systematic Review and Meta-Analysis of Randomized Trials.

(1) Background: Attention-deficit/hyperactivity disorder (ADHD) is typically treated with stimulant medications, which may lead to several adverse effects. Recent animal studies have shown that caffeine can improve the symptoms of ADHD. This systematic review and meta-analysis sought to evaluate the effect of caffeine on ADHD symptoms in children. (2) Methods: PubMed, Embase, and Cochrane databases were searched for randomized controlled trials comparing caffeine with placebo in children, comparing overall symptoms of ADHD, inattention, hyperactivity, and impulsivity. (3) Results: We included seven RCTs in the systematic review for qualitative assessment, with 104 patients aged 5 to 15 years. Four of these studies (n = 76) were included in the meta-analysis. After qualitative analysis, four studies indicated no improvement in any of the ADHD symptoms compared with placebo. One study showed improvement in ADHD symptoms based on 1 of 5 scales applied. One study indicated significant improvement in general symptoms, inattention, and hyperactivity. One study indicated improvement in sustained attention but a worsening of impulsivity. In contrast, when using a quantitative analysis of the general symptoms of ADHD, the data showed no significant difference when comparing placebo with caffeine (standardized mean difference -0.12; 95% CI -0.44 to 0.20; p = 0.45; I2 = 0%). (4) Conclusion: overall, the totality of the evidence suggests no significant benefit of caffeine over placebo in the treatment of children with ADHD.